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2023 BMC Elementary Summer Program
New Students
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Student's Last Name
*
Your answer
Student's First Name
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Your answer
Grade in Fall 2023
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2nd Grade
3rd Grade
4th Grade
5th Grade
Other:
If we offer afternoon sessions, would you prefer to switch to 1-4 pm time?
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Yes
No
Maybe
Tell us why you would like to enroll your child into the program. Please describe your child’s mathematical background and activities (if any).
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Your answer
Gender (For statistical purposes only)
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Male
Female
Other:
Parent 1: Email address
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Your answer
Parent 2: Email address
Your answer
Parent 1: Name
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Your answer
Parent 2: Name
Your answer
Parent 1: Phone
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Your answer
Parent 2: Phone
Your answer
Student's Address (Street/City/State/Zip Code)
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Your answer
School, Name, Address
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Your answer
Type of school
Private
Public
Other
Clear selection
Preferred Name
Your answer
What race/ethnicity do you most identify with?
American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, or Spanish origin
White (non-Hispanic or Latino)
Other:
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